Page title

About Your Child

Please Confirm Your Email Address (the one you used on the prior page)*

Student Preferred First Name*

Student Last Name*

Student Preferred Pronouns*

Student Birthday*

Student Phone

Student Email

Student School*

What medical conditions, allergies, learning differences or accommodations should we know about to make sure student is safe and has a great experience?*

Anything we should know so we can be the very best teachers and create the very best environment for them to learn in?

Emergency Contact Name and Phone*

(not you, someone else please)

Anything else you'd like share?

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